Laparoscopic Treatment Research Articles

Clinical experience in laparoscopic treatment of gallbladder perforation.

We herein present our clinical experience in laparoscopic surgery for gallbladder perforation (GBP). Retrospective analysis was performed on the clinical data of 44 patients who diagnosed with GBP from January 2015 to November 2020. The mean age of the 44 patients was 64.0 years and the female-to-male ratio was 20:24. The most common type of GBP was Type II, followed by Type I and Type III (31:9:4). 72.7% of the patients were diagnosed with GBP at the time of surgery. Laparoscopic surgery was performed for 38 (86.4%) patients, with a conversion rate of 13.2%. The mean length of hospital stays was 7.8 days. The mortality and morbidity rates were 2.3% and 11.4%, respectively. Pre-operative diagnosis of GBP is difficult. Laparoscopic surgery is safe, feasible and effective for patients with GBP.

Alternative Back-Up Approach for Inaccessible Laparoscopy in Cases of Huge Probably Benign Cystic Adnexal Masses

It comprised 28 consecutive reproductive non-pregnant women with above umbilicus huge probably benign cystic adnexal masses beyond the capacity of conventional laparoscopic intervention due to failed access of the intraumbilical primary trochar. Preoperative clinical, biochemical, and sonographic assessment of the cystic lesions revealed probability of benign nature of the cysts. Minilaparotomy (ML) followed by cyst aspiration utilizing a 10 mm laparoscopic trocar followed by cyst wall extraction for histopathology and ovarian refashioning.

Laparoscopic Surgical Treatment of GISTs in an Emergency and Elective Regime: Literature Review and Report a Case

Gastrointestinal Stromal Tumors (GISTs) are the most common mesenchymal tumors of the alimentary tract; they arise from the interstitial cells of Cajal [1], pacemaker cells interposed between the smooth muscle cells of the digestive tract and intramural neurons and characterized by the over expression of tyrosine kinase receptor C-Kit [2], (CD117), a type III tyrosine kinase receptor for stem cell growth factor, were found to be the source of GISTs [3].

Obstetric complications in women who underwent conservative myomectomy before pregnancy

The article presents a literature review devoted to the obstetric complications in pregnant women after conservative myomectomy. The attention is paid to such a complication as uterine rupture. The authors consider impractical to evaluate the uterine scar before pregnancy using ultrasound methods and hysteroscopy.Uterine rupture of any type should be documented in the medical history (published), which allows the clinicians and women to better understand factors associated with the risk for rupture and to inform the patient’s decision to deliver by cesarean section or through the vagina.A review and analysis of a case of uterine rupture in a patient after conservative myomectomy is also performed. A 40-weeks pregnant woman was taken to the operating room 12 hours after the start of the acute uterine rupture clinic and decrease of hemodynamic parameters. About 2 liters of blood was found in the abdominal cavity, and a tear up to 7 cm long was determined in the area of the uterine fundus, closer to the left uterine angle. In the female outpatient consultation, during the observation of a pregnant woman who had the laparoscopic intervention – myomectomy, a diagnosis of “scar on the uterus” was not established. Medical documentation providing information on prior surgery was ignored and was not required. During the observation of the pregnant woman, the method of childbirth was not considered by the doctor’s council, and prenatal hospitalization was not performed.By studying the modern scientific sources, there is very little data about factors what increase the risk of uterine rupture, such as penetration into the uterine cavity. Performance of laparoscopic intervention, as a rule, is associated with the implementation of reproductive function in the future. Obstetricians and gynecologists who perform surgical intervention should describe the operation protocol not formally, but taking into account the implementation of the reproductive function. For many women after myomectomy, vaginal delivery can be a safe and feasible option, with patient choice and informed consent regarding the mode of delivery is important. Women should be offered choice and provided with appropriate counseling using all available evidence and monitored during pregnancy and birth in health care institutions that support their choice. This article provides practical recommendations for the management of pregnancy and childbirth in patients who had conservative myomectomy.

Laparoscopy versus Laparotomy in the Surgical Management of Ectopic Pregnancy: Integrative Literature Review

Background: Ectopic pregnancy (EP) is a common gynecological emergency in resource-limited countries, where laparotomy is the conventional therapy despite the fact that laparoscopic surgery is considered the best option. There is a lack of prospective randomized evidence comparing laparoscopic surgery with laparotomy in the surgical care of women with REP. Objectives: To summarize current evidences comparing laparoscopy versus laparotomy in the surgical management of ectopic pregnancy. Methodology: PubMed, Web of Science, Science Direct, EBSCO, and Cochrane Library were utilized to identify the articles. In the current review, all pertinent articles related to both our topic and other articles were used. Other articles not related to the objective of the review were excluded. The research team looked through a standardized format in which the data had been extracted. Results: According to PRSIMA guidelines, our study included 13 published studies that were registered to extract final data from a total of 110 studies found after searching the mentioned databases, which were then used for title screening. Some were excluded from screening of abstracts and others due to different inclusion criteria, after full-text review. These 13 studies were used to compare laparoscopy versus laparotomy in the surgical management of EP, establishing that laparoscopic treatment of EP may be the most beneficial method with the highest level of safety and efficacy. Conclusion: Laparoscopic surgery is increasingly being used as the method of choice for treating EPs. When compared to laparotomy, laparoscopic treatment for EP raises concerns about safety, viability and results in fewer postoperative adhesions. Laparoscopy is also more practicable and proven to be more efficient in terms of blood loss, requirement for blood transfusion, need for analgesia, and time of postoperative hospital stay.

Features of laparoscopic and conventional decompression of the сeliac trunk

The OBJECTIVE was to study the efficacy and safety of laparoscopic decompression of the celiac trunk.METHODS AND MATERIALS. A comparative analysis of the results of laparoscopic (30 patients) and conventional decompression of the celiac trunk (50 patients) was carried out. All patients were operated on between September 2018 and July 2021.RESULTS. Intraoperative bleeding during laparoscopic decompression of the celiac trunk, which required conversion of access to laparotomy and vascular suture, was noted in 2 (6.7 %) cases. With conventional access, there were no such complications. The average duration of laparoscopic decompression of the celiac trunk was 107 minutes, from conventional access – 150 minutes. The average length of hospital stay after laparoscopic intervention was 4 days, after the traditional one – 7 days. Long-term results of treatment over a period of more than 6 months were evaluated in 28 patients who underwent laparoscopic decompression of the celiac trunk and 45 people who underwent conventional decompression. Ultrasound examination in all cases stated the return of linear and velocity parameters of blood flow in the celiac trunk to normal. complete relief of the clinical manifestations of the disease was achieved in 24 (85.7 %) patients after laparoscopic and in 39 (86.7 %) after traditional intervention.CONCLUSION. Laparoscopic decompression of the celiac trunk is an effective method of surgical treatment of the syndrome of compression of the celiac trunk, but there are risks of vascular damage. The long-term results of laparoscopic and open decompression of the celiac trunk are comparable.

Laparoscopic inguinal hernia repair: impact of surgical time in the learning curve.

One of the procedures that has become very popular thanks to the advantages of minimally invasive approach is the laparoscopic treatment of inguinocrural hernias. As a disadvantage, it would imply a longer learning curve when compared to the conventional approach. There is no consensus about the number of procedures required to dominate this surgical technique, since according to bibliography it ranges from 20 to 240. We analyzed and compared the progress of 18 third year surgical residents while they were introducing into laparoscopic transabdominal preperitoneal inguinal hernioplasties between June 2013 and May 2018. Between June 2013 and May 2018, 1282 laparoscopic inguinal hernioplasties were performed (71 procedures per resident). Mean surgical time was for unilateral: 62.13min (SD ± 15.54; range 30-105min) for the first third (Q1) vs 54.61min (SD ± 15.38; range 30-100min) for the last third (Q3): p < 0.0001. For bilateral were: 92.59min (SD ± 21.89; range 50-160min) for Q1 vs 84.48min (SD ± 20.52; range 30-130min) for Q3: p < 0.05. Accepting an alpha error of 5% and considering an association power of 80%, there would be needed 61 cases per surgeon to achieve a significant reduction in surgical time. In a center with high-volume in TAPP and under a supervised training program, it is feasible to achieve a reduction in surgical time. Randomized studies with a larger number of cases are necessary to confirm this finding and draw more robust and objective conclusions.

Necrotizing Fasciitis as an Early Postoperative Complication of Non-perforated Non-metastatic Rectal Cancer: Case Report and a Review of the Literature

Background: Necrotizing fasciitis is a life-threatening condition characterized by a rapid onset and aggressive degradation of the patient’s condition due to its fair prognosis. The brisk rate of necrotizing fasciitis evolution often makes diagnosing and treating it difficult, thus becoming fatal and incompatible with life. Case report: The authors report a rare case of a 62 years old woman, who had undergone a laparoscopic anterior rectal resection intervention. The patient presented stable with no co-morbidities. She had suffered different gastrointestinal symptoms during the last 2 months such as anorexia, diarrhea, and abdominal discomfort. She had also lost 6 kg in a 2-month time period. Imaging examinations (contrast CT) detected a rectal tumor stage CT4a N1 M0. No bowel perforations were detected. The team faced no perioperative complications. Later that day, she referred to having moderated pain around the surgical wounds that developed two days later with pain and mild diffuse hematoma in the left flank. This developed into necrotizing fasciitis and despite all the efforts she had an exitus lethalis on the 9 th postoperative day. Conclusions: Necrotizing fasciitis still remains a challenge to many specialists. In the context of malignancies, it is sometimes seen as a complication of perforated colon tumors. However, cases such as this, represent a challenge to many doctors due to their insidious characteristics. That is why it is important to search further into the mechanisms of this pathology. Keywords: necrotizing fasciitis, colorectal cancer, postoperative complication. DOI: 10.7176/ALST/96-01 Publication date: December 31 st 2022

Minimally invasive fundoplication for gastroesophageal reflux disease

: Gastroesophageal reflux disease (GERD), is one of the most common gastrointestinal diseases treated by physicians, with most patients being successfully managed medically. Patients with refractory or persistent disease may be treated using minimally invasive surgical techniques. Patients may also elect for surgical treatment of GERD to avoid the potentially deleterious effects of long term antisecretory [proton pump inhibitor (PPI)] use. Preoperative workup is critical to establish the presence of GERD, to rule out concomitant or alternative pathology, and to document the presence or absence of coexisting esophageal motility disorders. When the technical tenants are respected, laparoscopic fundoplication is a safe and effective treatment of GERD. The general principles involve adequate mobilization of the gastroesophageal junction and gastric fundus, high mediastinal dissection, and demonstration of adequate intraabdominal esophageal length. This is followed by secure closure of the diaphragmatic crura, as well as creation of a fundoplication to reinforce the typically hypotonic lower esophageal sphincter. The type of fundoplication used is typically influenced by preoperative manometry, presence of dysphagia, and patient age. Long term symptomatic relief, without the need for antisecretory medications, is achievable for the majority of properly selected patients. Postoperative morbidity and mortality are uncommon following laparoscopic treatment of GERD. The following manuscript describes our method for performance of both laparoscopic complete and partial fundoplication.

Comparison of open preperitoneal and transabdominal preperitoneal hernia repair for primary unilateral femoral hernia: a retrospective cohort study of 132 case.

Femoral hernia (FH) is traditionally treated by open surgery (OS). Laparoscopic treatment has also shown good results in treating FH. However, there have been few comparative studies of these two techniques. Therefore, our aim was to compare the outcomes of open and laparoscopic surgical FH treatment. Adult patients with primary unilateral FH undergoing OS or transabdominal preperitoneal (TAPP) hernia repair at our hospital from January 2013 to June 2018 were included in this study. Patients with history of abdominal surgery, contraindications to general anesthesia and those not wishing to receive general anesthesia received OS. Demographics, operation details and complications were compared retrospectively between the two groups. A total of 132 patients were recruited to the study, 62 and 70 of whom underwent OS and TAPP, respectively. Compared to OS group, the TAPP group had a significantly shorter hospital stay (3.0 vs. 2.0days, respectively, P < 0.05) and a lower postoperative pain score (3.0 vs. 1.0, P < 0.05), and took less time to return to normal activities (13.0 vs. 6.0days, respectively, P < 0.05). The overall complication rates were equivalent between the groups (10 vs. 9.7%, OR = 1.037, 95% CI 0.329-3.270). Both laparoscopic and open surgery appear to be safe and effective in a cohort of patients with femoral hernia and laparoscopic surgery might offer some advantages in reducing length of hospital stay, lower postoperative pain score and quicker return to activities.

Comparative study of open, laparoscopic and endoscopic treatments of intermediate grade vesicoureteral reflux in children.

Low-grade vesicoureteral-reflux (VUR) are rather treated by endoscopic injection, whereas open or laparoscopic procedures are mainly performed for high-grade VURs. Management of intermediate grades is controversial and no study focused on grade III to date. This study aims to compare the results of open, laparoscopic, and endoscopic approaches in children with grade III VUR. A multicenter comparative retrospectivestudy included children with grade III VUR operated for febrile urinary tract infections (UTIs) from 2007 to 2016. Children without UTI, with reflux of other grades, neurological bladder, duplex system, posterior urethral valves, and bladder exstrophy were excluded. Success was defined as no recurrence of febrile UTI and was presented as event-free survival curves. Out of 806 children operated of VUR, 171 met the inclusion criteria (114 females). Seventy-seven children (45%) underwent an open Cohen procedure, 35 (21%) a laparoscopic Lich-Gregoir and 59 (34%) a submucosal endoscopic injection according to the centers' preference. The mean follow-up was 64months (24-132). Groups were not different for age, sex, and circumcision status. Compared to Cohen procedure, recurrences of febrile UTI were more frequent after laparoscopic treatment (p = 0,02, 8/35) and endoscopic treatment (p = 0.001, 16/59). Redosurgery was also more frequent after laparoscopy (n = 2) and endoscopic injection (n = 14) than after open surgery (n = 0, p < 0.001). Recurrent febrile UTIs and redosurgery are more frequent after endoscopic and laparoscopic procedures in grade III VUR than open reimplantation. Whether the lower morbidity of laparoscopic or endoscopic approaches balances the risk of recurrent febrile UTI remains to be determined for intermediate grade reflux.

Preoperative Ultrasound Scoring of Endometriosis by AAGL 2021 Endometriosis Classification Is Concordant with Laparoscopic Surgical Findings and Distinguishes Early from Advanced Stages

To compare the accuracy of preoperative ultrasound (US) in predicting the laparoscopically defined 2021 American Association of Gynecologic Laparoscopists (AAGL) Endometriosis Staging. Retrospective multicenter study of patients treated at 3 specialized endometriosis centers. Three specialized endometriosis surgical centers in São Paulo (Brazil), Barcelona (Spain), and Avellino (Italy) participated. A total of 878 patients aged 15 to 45 years with no history of pelvic malignancy underwent laparoscopic (LPS) treatment for suspected endometriosis. Retrospective review of preoperative transvaginal and transabdominal US (index test) assessed for endometriosis at all sites used in the 2021 AAGL Endometriosis Classification and classified patients into AAGL-US stages 1 to 4. Results were compared with reference-standard LPS (AAGL-LPS) staging. The AAGL-US and AAGL-LPS stage were concordant in 586 cases (66.7%) (weighted kappa [WK] 0.759; intraclass correlation=0.906), with the highest agreement observed in patients with no endometriosis (n=70, 75.3% concordance), AAGL-LPS stage 1 (104, 50.7%) and stage 4 disease (358, 88.2%). Endometriosis was most accurately diagnosed in the rectum/sigmoid colon (WK 0.862), bladder (WK 0.911), and ovaries (WK 0.835/0.795 for right/left, respectively) and least accurately diagnosed at superficial peritoneal (WK 0.442), tubal (WK 0.391/0.363 for right/left, respectively), and retrocervical/uterosacral ligament (WK 0.656) sites. Sonographic estimation of the 2021 AAGL Endometriosis Staging is greatest in AAGL-LPS stages 1 and 4 and among patients with no endometriosis. US best identifies endometriosis of the ovaries, bladder, and bowel but is more limited for the tubes and superficial peritoneum.

Clinical Study of the Application on Transvaginal Single-Port Laparoscopy in Treatment of Acute Appendicitis

Clinical Study of the Application on Transvaginal Single-Port Laparoscopy in Treatment of Acute Appendicitis

7292 Laparoscopic Foetal Extraction and Repair of Uterine Rupture at 20 Weeks of Gestation

<h3>Study Objective</h3> To demonstrate the viability of laparoscopic intervention for uterine rupture in selected cases. <h3>Design</h3> Case report. <h3>Setting</h3> Hospital with ICU facility. <h3>Patients or Participants</h3> A 28-year-old G4 P2 A1 with uterine rupture at 20 weeks looking to preserve her fertility. <h3>Interventions</h3> Laparoscopic intervention instead of laparotomy for a ruptured uterus. <h3>Measurements and Main Results</h3> Termination of pregnancy is a common medical procedure performed in the second trimester when the foetus has multiple anomalies. Termination of mid-trimester pregnancy constitutes about 10 to 15% of all abortions worldwide. We demonstrate a laparoscopic approach for foetal extraction which will definitely benefit the patient especially when she is planning to have another baby. <h3>Conclusion</h3> Uterine rupture is a rare complication following induction of labour for the termination of pregnancy with previous surgeries. It is usually associated with severe lower abdominal pain and sudden cessation of contractions along with haemorrhagic shock caused by intra- abdominal haemorrhage. Laparotomy is the standard procedure to repair uterine rent or to perform a hysterectomy. Here, we present a case of uterine rupture in a patient at 20 weeks of gestation who underwent termination of pregnancy by induction of labour for multiple fetal anomalies. Patient was successfully managed by laparoscopy. It suggests that laparoscopy can be an effective approach in the treatment of uterine rupture for hemodynamically stable patients.

Anesthetic prediction model in laparoscopic surgery in children

Our study analyzes anesthesia with sevofluran through the prism of 5 regress models on the results of 5 anesthetic parameters, systolic pressure, diastolic pressure, pulse, respiratory frequency, oxygen saturation in the blood periferic. For the elaboration of the optimal model carried out a selection of 5 main approximation functions, including linear, logarithmic, exponential, power, polynom. A correlation analysis of the effect of Sevoflurane on all anesthetic parameters was performed. The regression model with the polynom function most accurately reflects the real situation. During laparoscopic intervention, 3 anesthesiologist parameters turned out to be informative, namely systolic pressure, pulse, respiratory rate. Sevoflurane has a significant effect on the pulse (the first place in the power of influence), on systolic pressure (the second place), on respiratory frequency (third place). Graphically, the dynamics of all optimal models with the result of the coefficient of determination is presented in detail.

8934 Laparoscopic Isthmocele Repair

<h3>Study Objective</h3> The treatment of symptomatic isthmoceles can be medical (with oral contraceptives) in small defects (residual myometrium greater than 3 mm), and by minimal invasion in large defects or those small that did not respond to medical treatment. In defects with residual myometrium > 3 mm, the correction is done by hysteroscopy. The fibrotic tissue of the defect is removed, the edges of the niche are resected, achieving continuity of the uterine wall with the cervical canal, and the base is fulgurated to remove inflamed tissue. In defects with residual myometrium <3 mm, laparoscopic treatment is recommended. The edges are resected to remove scar tissue, and the defect is closed with two-layer sutures. The combination of hysteroscopy-laparoscopy allows transillumination of the defect by hysteroscopy and laparoscopic correction, which also allows the treatment of other causes of pain and infertility, as well as mobilization of the bladder and revision of tubal patency. Surgery improves HUA, chronic pelvic pain, and infertility in 71.4%, 83.3%, and 83.3%, respectively, based on a case series. Hysterectomy is reserved for patients who do not wish to be fertile or who have persistent symptoms after conservative treatment. <h3>Design</h3> Video of hysteroscopy-guided laparoscopic isthmocele correction surgery. Informed consent of the patient. Literature review. <h3>Setting</h3> Proceeding in a pre-scheduled manner, under general anesthesia in the Trendelenburg position, with access to the abdominal cavity under a routinely specified pneumoperitoneum for the consequent inspection of the pelvic abdominal cavity <h3>Patients or Participants</h3> Patients with defects with residual myometrium <3 mm. <h3>Interventions</h3> Laparoscopic correction of isthmocele. <h3>Measurements and Main Results</h3> N/A. <h3>Conclusion</h3> Patients with large isthmoceles with <3mm residual myometrium benefit from hysteroscopy-assisted laparoscopic isthmoplasty.

A Case of Aberrant Pancreatic Cancer in the Small Intestine with Laparoscopic Treatment

A Case of Aberrant Pancreatic Cancer in the Small Intestine with Laparoscopic Treatment

Pancreatic pseudocyst in children

Pancreatic injuries include a variety of injuries from simple contusion to complete rupture of the duct and pancreatic head. Although pancreatic lesions are rare in children, the pancreatic pseudocyst is the most common posttraumatic cystic lesion of the pancreas and is a localized collection containing pancreatic juice and the peripancreatic necrotic test. The management of the pancreatic pseudocyst has evolved from the stage of exclusive surgical treatment exclusively, to the conservative one, respectively the stage of minimally invasive treatment (percutaneous drainage, endoscopic drainage) and laparoscopic treatment. However, the management remains controversial, the approach depending on the type of lesion, size and evolutionary characteristics. This paper presents the case of a pediatric patient, polytrauma due to a rail accident who is diagnosed 3 weeks after hospitalization with a pseudocyst of the pancreas. We will present both he diagnostic means and the management, both medicinal and surgical, as well as the subsequent evolution of the patient.

8849 Niamh Joyce MD, OBSTETRICS AND GYNECOLOGY, MRCOG, Fellow in Reproductive Medicine

<h3>Study Objective</h3> Video demonstration of fertility sparing laparoscopic treatment for a symptomatic Müllerian Tract abnormality <h3>Design</h3> Single Case Report. <h3>Setting</h3> Tertiary Academic Hospital. 3 port laparoscopy, with patient in Trendelenburg Lithotomy position <h3>Patients or Participants</h3> A 16-year-old nulliparous patient presented with intractable dysmenorrhea since menarche aged 15, associated with syncope. There was no response to analgesia or hormonal contraception and the impact on quality-of-life necessitated surgical review. Initial assessment by pelvic ultrasound identified normal ovaries and uterus but a solid appearing right adnexal lesion. Further imaging by MRI showed evidence of a double uterus with only the left sided uterus communicating with the vagina in keeping with an ASRM class II(b) abnormality. Differential diagnosis included Mullerian duct abnormality and accessory and cavitated mass. A uterine didelphys with only a left ostia was seen on hysteroscopy. Laparoscopy showed a uterine didelphys with a non-communicating, engorged right uterus and right fallopian tube. Her case was discussed at a multidisciplinary meeting where it was decided the most suitable treatment was to perform a laparoscopic hemi-hysterectomy with right salpingectomy to remove the right sided non communicating cavity and tube. This procedure was recorded with the patient's consent and will be shown as part of the video presentation. <h3>Interventions</h3> Laparoscopic hemi-hysterectomy for resection of non-communicating uterine horn. EBL minimal. Operative time 37 Mins, hospital stay 1 night. <h3>Measurements and Main Results</h3> A successful laparoscopic intervention was performed, and the patient was discharged day 1 post op. Review at clinic revealed completed resolution of symptoms, normal menses. Future fertility was a primary concern and was successfully conserved. Histology demonstrated a functioning endometrial cavity with focal adenomyosis. <h3>Conclusion</h3> Class II Müllerian abnormalities are uncommon, affecting around 0.06% of females. Symptoms can include pain or menstrual dysfunction as well as fertility/obstetric complications. When necessary, a minimally invasive approach can be utilized to treat these conditions.

Laparoscopic Management of an Atypical Presentation of a Large Degenerated Fibroid during Pregnancy

<h3>Study Objective</h3> Key steps in management of atypical presentation of large uterine fibroids during pregnancy. <h3>Design</h3> McMaster University Medical Centre. <h3>Setting</h3> Case Review. <h3>Patients or Participants</h3> Single case. <h3>Interventions</h3> Expert Ultrasound evaluation. <h3>Measurements and Main Results</h3> Safe laparoscopic intervention guided by ultrasound for management of large fibroids during pregnancy. <h3>Conclusion</h3> This video highlights key strategic steps in evaluating an atypical presentation of uterine fibroid degeneration during pregnancy. Management strategies include a careful review of the patient's history, appropriate physical exam, and evaluation of prior imaging studies. The role of expert ultrasound evaluation is crucial to the patient's care as it provides more insight into the pathology encountered, which will facilitate an appropriate treatment plan after reviewing the available options. Collaboration with other teams is essential to provide a complete analysis that will ultimately ensure patients' autonomy in the process. In addition to the above, laparoscopic surgery is a feasible option during pregnancy that allows direct evaluation and specifically in this case diagnosis and surgical intervention with the aim to prolong a safe pregnancy.